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Citation
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Winkler SL, Finch D, Wang X, Toyinbo P, Marszalek J, Rakoczy CM, Rice CE, Pollard K, Rhodes MA, Eldred K, Llanos I, Peterson M, Williams M, Zuniga E, White H, Delikat J, Ballistrea L, White K, Cockerham GC. Optom. Vis. Sci. 2021; ePub(ePub): ePub. |
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Abstract
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SIGNIFICANCE: We know the prevalence of traumatic brain injury (TBI) related vision impairment and ocular injury symptoms. Lacking is an understanding of healthcare utilization to treat these symptoms. Utilization knowledge is important to structuring access to treatment, identifying clinical training needs, and providing evidence of the effectiveness of treatment.
PURPOSE: This manuscript reports rehabilitation, glasses/contacts, and imaging/photography/ video recommendations made by optometrists and ophthalmologists as part of the VA mandated Performance of Traumatic Brain Injury Specific Ocular Health and Visual Functioning Examination administered to Veterans with TBI at VA polytrauma specialty facilities.
METHODS: Using a retrospective design, natural language processing, descriptive and regression statistics, data were analysed for 2,458 Operation Enduring Freedom/Operation Iraqi Freedom veterans who were administered the mandated exam between 2008 and 2017.
RESULTS: Of the 2,458 veterans, vision rehabilitation was recommended for 24%, glasses/contacts were recommended for 57% and further imaging/photography/video testing were recommended for 58%. Using key words in the referral, we determined that 37% of veterans were referred to Blind Rehabilitation, 16% to Occupational Therapy, and 3% to Low Vision Clinics. More than 50% of the referrals could have been treated by Blind Rehabilitation, Occupational Therapy, or Low Vision clinics. Rehabilitation referrals were significantly associated with younger age, floaters, photosensitivity, double vision, visual field and balance deficits, dizziness, and difficulty reading. In comparison, prescriptions for glasses and contacts were associated with older age, photosensitivity, blurred vision, decreased visual field and night vision, difficulty reading, and dry eye. Imaging/photography/video testing were associated with floaters, photosensitivity and headache.
CONCLUSIONS: Findings delineate service delivery models available to veterans with TBI-related vision impairment. The challenge these data address is the lack of clear paths from diagnosis of TBI to identification of vision dysfunction deficits to specialized vision rehabilitation, and finally to community reintegration and community based-vision rehabilitation.
Language: en |